Review Nurse Jobs in the United States
Providence Health and Services
San Fernando, CA
See Providence Health and Services Terms & Conditions at https://www.providence.org/utility-pages/privacy-policy#terms-of-use and Privacy Policy at https://www.providence.org/utility-pages/privacy-policy#privacy-policy and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Lumen Solutions Group, Inc.
Baltimore, MD
We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.
Incredible Health
$59030 - $77630
Macon, GA
Employer features: Academic medical center, Adoption Assistance, Best Places to Work recognition, Career Advance Program, Community hospital, Disability Insurance, Family Care Benefits, FSA, Health Insurance, Level 1 trauma center, Level 2 trauma center, Level 4 trauma center, Life Insurance, Magnet recognized, Medical, Offers sign on bonus, PTO, Retirement Plan, Teaching Hospital, Tuition Assistance, U.S. News best hospital . Hospitals on Incredible Health are actively hiring and accepting applications in the Macon, GA area for the following position: Registered Nurse - Utilization Review.
Providence Health and Services
$43.29 - $76.06
Jber, AK
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, outreach programs, and hospice and home care. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Christus Health
Irving, TX
Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services.
Williamson Health
Murfreesboro, TN
The flagship facility, Williamson Medical Center, which recently opened its new Boyer-Bryan West Tower, offers extensive women's services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Timely reviews patients within 24 hours or next business day after admission and at a minimum of every 2 days thereafter for continued stay, applying appropriate criteria (Interqual®) and facilitating reimbursement for services with third payer parties, obtaining and entering authorization number/approval status and notes in Meditech.
GetMed Staffing
$2180.28
Everett, WA
Traveling with GetMed Staffing offers the unique opportunity to gain diverse experiences, both personally and professionally. GetMed Staffing is searching for a strong Utilization Review RN to assist our traveler-friendly client.
Prime Staffing
$2307.2
Washington, DC
The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs. Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays.
St. Luke's University Health Network
Allentown, PA
Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The RN DRG Downgrades Appeals Review Specialist is responsible for the retrospective clinical review and defense of inpatient DRG downgrades, clinical validation denials, and medical necessity determinations issued by governmental and commercial payers.
Prime Staffing
$2605.2
Orange, CA
The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs. Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays.
CHRISTUS Health
Irving, TX
Outreach to TOC patients should focus on medication reconciliation/adherence, self-management, use of personal health records, follow-up with PCPs/Specialists, and review of indicators that a patient’s condition is worsening and how to respond. Promotes a positive work environment by displaying a caring, sensitive approach to others, as evidenced by listening, understanding, and responding to the needs of patients, colleagues, and supervisors.
Kinetic Personnel Group
Ontario, CA
Requirements: Three (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Spectraforce Technologies Inc
Atlanta, GA
Configuration support will be for both pharmacy and medical criteria and will require good creative problem solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency. Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers.
Valley Manor Care Center
$37.45 - $44.95
Eckert, CO
While providing care to our patients, we want our staff to feel cared for and love their work while maintaining a work-life balance, so offering employees paid-time off benefits is a part of our comprehensive benefits package Our diverse and involved staff members are supported by the commitment to maintain relationships of functional trust with every team member, to always practice solutions-focused problem solving, and to continually affirm each team member’s contribution to the quality of our work. Provides Leadership and Direction on Assigned UnitRole models positive communication skills with NA/R’s, C.N.A.’s, STNAs, TMA’s (if applicable), interdisciplinary team, supervisory and management team, customers, residents and families.
Pyramid Consulting, Inc
$75 - $85
Santa Clara, CA
Utilization Management:-Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners.
TechLink Systems, Inc.
Everett, WA
Guaranteed Hours: 72 hours per 2 week period. Total Weekly Hours: 40 Start date: ASAP.
GQR Healthcare
$1768 - $1863
Washington, DC
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1860 - $1955
Alamogordo, NM
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2352 - $2447
Anchorage, AK
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$1315 - $1410
Windom, MN
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2662 - $2757
Oakland, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2557 - $2652
Burlingame, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2511 - $2606
Falls Church, VA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2065 - $2160
Seattle, WA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2007 - $2102
Detroit, MI
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2150 - $2245
Portland, OR
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2110 - $2205
Santa Barbara, CA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
GQR Healthcare
$2500 - $2595
Falls Church, VA
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
Convergence Medical Staffing
$2286
Kinston, NC
Job Nurse - Utilization Review @ UNC Health Lenoir, City: Kinston, State: North Carolina, Estimated Start , Shift:5 x 8 Hour Day Shift, 07:00:00-15:00:00, 8.00-5, Length of Contract (Days) : 91, Estimated Gross Pay: 0.00. The Convergence Medical Staffing Mobile App enables our travelers to search for jobs as well as upload and manage needed information quickly and simply, thus allowing for speedy submittal to facilities.
MRG Exams
$120000 - $130000
Yuba City, CA
This role involves conducting focused, in-person physical exams and reviewing medical records electronically to complete the required documentation for the VA. We are seeking a dedicated Nurse Practitioner (NP) or Physician Assistant (PA) to join our team in performing medical assessments for U.S. Veterans as part of the VA's disability benefits process.
MRG Exams
Wilton, MN
This role involves conducting focused, in-person physical exams and reviewing medical records electronically to complete the required documentation for the VA. We are seeking a dedicated Nurse Practitioner (NP) or Physician Assistant (PA) to join our team in performing medical assessments for U.S. Veterans as part of the VA's disability benefits process.
MRG Exams
Forest, VA
This role involves conducting focused, in-person physical exams and reviewing medical records electronically to complete the required documentation for the VA. We are seeking a dedicated Nurse Practitioner (NP) or Physician Assistant (PA) to join our team in performing medical assessments for U.S. Veterans as part of the VA's disability benefits process.
GQR Healthcare
$1931 - $2026
Greensboro, NC
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
Sanford Health
$31 - $49.5
Fosston, MN
Gathers clinical data, prepares summary reports, and presents findings derived from data systems and ongoing monitoring activities to persons and committees for use in Medical Staff peer review processes and activities to include case review, Ongoing and Focused Professional Practice Evaluation, and evaluation of provider applications for appointment, reappointment and request for clinical privileges. Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
GQR Healthcare
Sundance, WY
Role Overview - RN responsible for case management across acute care, swing bed, and outpatient services. Focus on discharge planning, utilization review, care coordination, and CMS compliance.
National Staffing Solutions
$1826.55 - $2109.45
Kinston, NC
We`re currently seeking a RN - Utilization Review to join our amazing team with the following qualifications: One or more year(s) of experience as a RN. Licensed to practice as a RN with active license(s) in the state(s) in which employed and practices.
Rosemont - a HumanGood community
$31.9
Philadelphia, PA
As our Licensed Practical Nurse, you will be responsible for the nursing needs of residents, while actively incorporating our “Philosophy for Person-Directed Care.” The Mansion at Rosemont, recognized by U.S. News & World Report as “Best of Senior Living” 2022-23, is hiring a Part-Time LPN to join our team!
Signify Health
$2500 - $4000
Benton, KY
You will be provided a pre-populated, patient-specific form for each evaluation and do not prescribe medicine, order lab tests, or alter people’s current treatment regimen. We’re hiring board-certified nurse practitioner contractors to conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members.
Lancesoft Inc
$2230
Apple Valley, CA
Years of experience REQ: 3-year acute medical Care Manager/UM experience performing utilization review in a hospital setting (not health plan/medical group). • First-timers accepted: Seasoned traveler is required Hardstop.
Maplewood Brewster LLC
Hyannis, MA
Summary: The Resident Services Nurse (Registered Nurse) is responsible for assisting the Resident Services Director with the overall implementation, delivery, and coordination of Resident Care Services at the Community. Supervise Resident Services Department associates, including C.N.A.’s (Resident Services Assistants).
Maplewood Brewster LLC
Marstons Mills, MA
Summary: The Resident Services Nurse (Registered Nurse) is responsible for assisting the Resident Services Director with the overall implementation, delivery, and coordination of Resident Care Services at the Community. Supervise Resident Services Department associates, including C.N.A.’s (Resident Services Assistants).
Mindlance Health
$40 - $45
Goldsboro, NC
Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
GQR Healthcare
$1357
Brownsville, TX
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership.
GQR Healthcare
$1524
Tallahassee, FL
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership.
GQR Healthcare
$1357
Round Rock, TX
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership.
GQR Healthcare
$1740
Fort Wayne, IN
Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership.
Mindlance Health
$40 - $45
Temple, TX
Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
Truhealth
New Orleans, LA
TruHealth is seeking an advanced practice provider, either a nurse practitioner (NP) or physician assistant (PA) with experience in primary care or internal medicine, preferably with geriatrics focus. If you are an advanced practice registered nurse (APRN or NP) or physician assistant (PA) who enjoys working with the aging population, consider joining the TruHealth team.
Partners in Care Foundation In
$80000 - $95000
San Fernando, CA
The Clinical Consultant RN or Licensed Clinical Social Worker, LCSW partners with Care Managers, Behavioral Health clinicians, Primary Care Providers, hospitals, Managed Care Plans, and community-based organizations to ensure high-quality, whole-person, and evidence-based care. This role supports interdisciplinary care teams serving individuals with complex medical, behavioral health, and social needs, including people experiencing homelessness, serious mental illness, substance use disorders, chronic disease, and socioeconomic instability.
TruHealth
Cartersville, GA
Part of American Health Partners, we include the fastest-growing provider-owned Medicare Advantage plans, plus divisions in psychiatric care and pharmacy services. At TruHealth, we’re transforming care for seniors in long-term care with an innovative, proactive model that promotes dignity, independence, and quality of life.